Shortness of breath from heart failure

Depending on the stage of
heart failure, shortness of breath may occur:

With exertion or exercise.

At
rest.

While lying down (orthopnea). This often is relieved by
sitting up or standing.

At night, and it may occur with waking up
coughing and/or wheezing, having a rapid heart rate, and a feeling of being
suffocated (paroxysmal nocturnal dyspnea).

What characterizes shortness of breath from heart failure?

People with heart failure experience shortness of breath in many
different ways. Most people describe it as being winded, having a tightness in
the chest, or even feeling tired while walking. You may also experience
shortness of breath from heart failure at specific times—when you exercise or
overexert yourself, while you are lying down, and while you are
sleeping.

Shortness of breath from exertion. If your
shortness of breath is not severe, you may notice it only when you are exerting
yourself, and sometimes only during more intense exertion. For example, you may
notice that you are short of breath after walking up three flights of stairs,
whereas before, you were comfortable walking up four flights. The medical term
for this symptom is dyspnea (say "DISP-nee-ah").

When heart failure develops gradually, your shortness of breath also
may develop gradually, which can make it hard to notice. People with more
severe heart failure, however, may experience shortness of breath with minimal
exertion, even from just combing their hair. In the most severe cases,
shortness of breath can become so serious that you require continuous oxygen
therapy.

While shortness of breath is the most common symptom of heart
failure, it may be difficult or impossible to distinguish it from shortness of
breath caused by other health problems such as emphysema or severe anemia. Your
doctor can help you determine why you have been feeling short of breath.

Shortness of breath while lying down. People
with more severe heart failure may experience shortness of breath when they lie
down. The medical term for this symptom is orthopnea (say "or-THOP-nee-ah"). The
severity of this symptom usually depends on how flat you are lying—the flatter
you lie, the more you feel short of breath.

To gauge the severity of this symptom, doctors often ask people how
many pillows they need to lie on to avoid feeling short of breath in bed. For
example, "three-pillow" orthopnea is worse than "two-pillow" orthopnea because
you have less tolerance for lying flat.

The reason you may have orthopnea is that when you lie flat, the
blood that ordinarily pools in the veins of your legs is reentering your
bloodstream. If you have heart failure, your heart may not be able to keep up
with the increased amount of blood returning to the heart, so fluid builds up
inside the lungs and causes shortness of breath.

Shortness of breath while sleeping. Some
people with heart failure wake up in the middle of the night with severe
shortness of breath. The medical term for this symptom is paroxysmal nocturnal
dyspnea (PND). In general, people who experience PND do not feel increased
shortness of breath when they first lie down. However, after several hours of
lying down, they awake with shortness of breath, which often occurs suddenly.
People who experience PND often have to sit up on the side of the bed, and they
may feel a need to open a window to get more air. The shortness of breath
generally goes away after a few minutes of sitting up.

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